Provider Demographics
NPI:1689761363
Name:KOEHLER, SHIRLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:KOEHLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78839-0725
Mailing Address - Country:US
Mailing Address - Phone:830-374-2952
Mailing Address - Fax:830-374-3784
Practice Address - Street 1:210 S AVENUE C
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78839-3834
Practice Address - Country:US
Practice Address - Phone:830-374-2952
Practice Address - Fax:830-374-3784
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM92PA01363A00000X
TXPA01316363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96694Medicaid
NM96694Medicaid